L.F. Jiang et al. / Health 3 (2011) 39-42
Copyright © 2011 SciRes. Openly accessible at http:/ /www.scirp.org/journal/HE ALTH/
PT(S) 22.43 ± 6.02 32.38 ± 10.08 0.045
other anti-fungal treatment, and some of them even used
combined drug therapy. Result: Among 27 liver failure
patients complicated by invasive fungal infection, mor-
tality rate was 63.00%, which included auto-discharged
patients. 3 patients suffered from fungal pneumonia and
1 case having fungal sepsis died.
4. DISCUSSIO N
Fungi are widespread in nature as conditional patho-
gen, which exist in skin or mucous membrane and cause
infection by invasion when organism is in low immunity
[5]. Because of long time hospitalization, liver failure
patients were easy to show various complications such
as ascites, water-electrolyte imbalance and so on. Con-
ducted many kinds of invasive medical manipulation
which include abdominal paracentesis, deep venous ca-
theterization etc. Long term use of broad-spectrum anti-
biotics. Due to above factors, the opportunity of invasive
fungal infections significantly increases. Liver failure
patients would be further aggravate in liver damaged,
even lead to death if complicated by infection [6].
The pathogenic fungi of 27 liver failure patients with
invasive fungal infection were mainly Candida, which
was consistent with the results reported by Zhang Xu-
ehai, etc. [7] and Xie Min et al. [8]. This result illu-
strated that Candida were widely distributed in nature
and stronger pathogenicity in organism. Aspergillus in-
fection was once considered uncommon in the past [9],
but aspergillus infection rate in this group was 12.90%
(4/27), all for lung infection, and mortality rate was 75%.
The infection sites’ constitution ratios were respiratory
tract infections (58.06%), intestinal tract infections
(35.48%). The above summary indicated that spectrum
of fungal infection in severe hepatitis patients was ex-
panding with the improvement of diagnosis. The disease
severity was more complex and more emphasis should
be laid.
Liver failure patients combined with invasive fungal
infection were not obvious and specific clinical manife-
stations. It was not easy to identify the sym ptoms of liv-
er failure itself. After fungal infections, the majority of
patients would be exacerbated. The white blood cell
(WBC), serum bilirubin (TBIL), prothrombin time (PT)
were analyzed before and after fungal infection in pa-
tient with liver failure, there was statistically differ-
ent .These patients occurred conditions ( i.e., unexplained
fever, deteriorated disease progress, aggravated systemic
symptoms, poor effect of application broad spectrum
antibiotics) should be highly vigilant against invasive
fungal infection. Routine fungal examination should be
carried out to facilitate early diagnosis and give antifun-
gal treatment on time.
In this group, 27 cases with fungal infections occurred
in 6-55 days after adm is sion, al l exi sted in br oad-spectrum
antibiotic usage and invasive operation. Part of them used
hormone inside or outside hospital .According to the re-
port by Xie Min et al. [8], application of broad-spectrum
antibiotics, invasive operation, hormone usage, and dis-
eases severity etc., were closely related to liver failure
complicat ed by funga l i nfe cti ons.
Because of the complexity of fungal infection, multi-
tiered treatment were advocated in current treatment,
including preventive therapy, empirical therapy, preemp-
tive therapy and targeted therapy [4], specific fungus
preventive treatment in clinical work for high-risk pa-
tients could reduce incidence of invasive fungal infection
[10]. Amphotericin B, fluconazole, itraconazole, and vo-
riconazole are main therapeutical drugs for IFI now.
Amphotericin B has obvious adverse reaction, and most
patients are hard to tolerate. It has been reported that flu-
conazole had good anti-fungus effect [11]. The antimi-
crobial spectrum of fluconazole is nar row, and it is mai n-
ly sensitive to candida albicans, but not valid for
non-candida albicans and aspergillus. Furthermore, can-
didal drug resistance obviously increases after long-term
use [12]. Itraconazole has certain hepatotoxicity, so it is
cautiously used in severe hepatitis patients. Voriconazole
is a type of broad spectrum antifungal agent, and it has
good safety. Antifungus spectrum of voriconazole covers
main pathomycete such as candida, aspergillus, Crypto-
coccus and it is now a good choice for IFI therapy [12].
Therefore, even though most patients were executed an-
ti-fungal treatment, mortality was 63.00%, according to
report Xie Min et al. [7]. The mortality of liver failure
patients without complicated by fungal infections was
37.78%. This indicated that invasive fungal infection
would make liver failure more serious and increase the
mortality rate sig n ifican tly f urth er aggravated the original
liver failure an d increased the mortality ra te sign ificantly
in liver failure patients.
Currently the patients with liver failure do not have
specific treatment, but only early diagnosis and early
treatment; actively to prevent liver cell necrosis and
promote liver regeneration, positively treat etiology and
prevent complications [14]. For the liver failure patients,
according to clinical data analysis of invasive fungal in-
fection in this paper, we believe that some clinical work
should be paid attentation to, including 1) treat primary
disease, strengthen nutritional support , stabilize internal
environment, enhance body resistance; 2) rational use of
antibiotics, avoidance of the abuse in broad-spectrum
antibiotics and careful use of hormones; 3) reduction of
invasive operation as far as possible, strict implementa-
